Tschabrunn Cory M, Pothineni Naga Venkata K, Sauer William H, Doynow Daniel, Salas Jonathan, Liao Ting-Wei Ernie, Santangeli Pasquale, Arkles Jeffrey, Hyman Matthew C, Frankel David S, Supple Gregory E, Garcia Fermin C, Nazarian Saman, Dixit Sanjay, Epstein Andrew E, Schaller Robert D, Callans David J, Marchlinski Francis E
Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA; Penn Cardiovascular Institute, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Cardiac Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC Clin Electrophysiol. 2020 Jun;6(6):684-692. doi: 10.1016/j.jacep.2020.02.013. Epub 2020 May 27.
This study investigated the impact of the type of catheter irrigant used during delivery of radiofrequency ablation.
The use of half-normal saline (HNS) as an irrigant has been suggested as a method for increasing ablation lesion size but has not been rigorously studied in the beating heart or the use of a low-flow irrigation catheter.
Sixteen swine underwent left ventricular mapping and ablation using either normal saline (NS) (group 1: n = 9) or half-normal saline (HNS) (group 2: n = 7). All lesions were delivered using identical parameters (40 W with 10-second ramp, 30-second duration, 15 ml/min flow, and 8- to14-g target contact force). An occurrence of steam pop, catheter char, or thrombus was assessed using intracardiac echocardiography and catheter inspection following each application. Lesion depth, width, and area were measured using electronic calibers.
A total of 109 lesions were delivered in group 1 and 77 in group 2. There were significantly more steam pops in group 2 (32 of 77 [42%] vs. 24 of 109 [22%], respectively). The frequencies of catheter tip char were similar (group 1: 9 of 109 [8%] vs. group 2: 10 of 77 [13%]; p = 0.29). Lesion depths, widths, and areas also were similar in both groups.
The use of an HNS irrigant using a low-flow open irrigated ablation catheter platform results in more tissue heating due to higher radiofrequency current delivery directed to tissue, but this can lead to higher rate of steam pops. In this in vivo porcine beating-heart model, the use of HNS does not appear to significantly increase lesion size in normal myocardium despite evidence of increased radiofrequency heating.
本研究调查了在进行射频消融时所用导管冲洗液类型的影响。
有人提出使用半生理盐水（HNS）作为冲洗液可作为增加消融灶大小的一种方法，但在跳动心脏或使用低流量冲洗导管方面尚未进行严格研究。
16头猪接受了左心室标测和消融，其中9头使用生理盐水（NS）（第1组），7头使用半生理盐水（HNS）（第2组）。所有消融均采用相同参数（40瓦，10秒斜坡上升，30秒持续时间，15毫升/分钟流速，8至14克目标接触力）。每次消融后，使用心内超声心动图和导管检查评估是否出现蒸汽泡、导管烧焦或血栓。使用电子卡尺测量消融灶的深度、宽度和面积。
第1组共进行了109次消融，第2组共进行了77次消融。第2组出现蒸汽泡的情况明显更多（分别为77次中的32次[42%]和109次中的24次[22%]）。导管尖端烧焦的频率相似（第1组：109次中的9次[8%]，第2组：77次中的10次[13%]；p = 0.29）。两组的消融灶深度、宽度和面积也相似。
在低流量开放式冲洗消融导管平台上使用HNS冲洗液会因更高的射频电流传递至组织而导致更多组织发热，但这会导致蒸汽泡发生率更高。在这个体内猪跳动心脏模型中，尽管有证据表明射频加热增加，但使用HNS似乎并未显著增加正常心肌中的消融灶大小。
